HJAR Sep/Oct 2019

HEALTHCARE JOURNAL OF ARKANSAS  I  SEP / OCT 2019 47 glucose values, for children with the diag- nosis of T2D (2, 3). It is beyond the scope of this text to review these medications in detail, but all forms of dysglycemia require intensive lifestyle modification, including adding exercise into the daily routine and reducing calorie consumption, or even ed- ucation in carbohydrate restriction. At Arkansas Children’s, we recommend at least a 5–10 percent reduction in body weight as a goal for our patients. Consul- tation with a Registered Dietitian (RD) and Certified Diabetes Educator (CDE) at ini- tial diagnosis is critical. In general, for an A1c between 6.4–8.4 percent, we start with metformin. If A1c goals (<7 percent, for ex- ample) are not met, more intensive treat- ment is recommended, such as beginning subcutaneous basal insulin. The process of starting insulin in a pediatric patient with T2D always requires education from a provider, diabetes educator, and registered dietician. Despite growing recognition, T2D in youth remains underdiagnosed and poor- ly understood. Further, the treatment of T2D in youth should not mirror the path- ways well-known for adults. Children tend to progress much more rapidly and are prone to both Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome, or a mixture thereof. Both of these com- plications are life-threatening, but are preventable with appropriate education, treatment, and follow up methods. It is therefore absolutely critical that children with any form of abnormal blood sugar be immediately referred to, or discussed in consultation with a specialist in pediatric endocrinology. n “Despite growing recognition, Type 2 Diabetes in youth remains underdiagnosed and poorly understood.” Brittany Blankenship, MSN, RN, CPN RN III COED/Diabetes/Endocrine Specialty Nurse Morgan Butler, MSN, RN, CDE RN III Diabetes Specialty Nurse Heather Cantrell, APN, MNSc, CPNP-AC, BCADM, CDE Advanced Practice Nurse for Endocrine and Diabetes Dr. Oden is a board-certified Pediatric En- docrinologist. He has devoted much of his career to the development of outpatient pro- grams for children with diabetes and obesity. Upon moving to Little Rock in 2015, he began work with the weight management program within Arkansas Children’s and volunteers his time every summer with Camp Aldersgate. Heather Cantrell is an Advanced Practice Registered Nurse for Endocrine and Diabetes at Arkansas Children’s Northwest in Spring- dale Arkansas. She is also a Certified Diabetes Educator and Board Certified in Advanced Di- abetes Management. Her passion is caring for children with Diabetes of all types as well as prevention of complications associated with pediatric obesity. Morgan is a Certified Diabetes Educator at Arkansas Children’s Hospital. Since joining the Department of Pediatric Endocrinology and Diabetes, Morgan has taken a specific interest in education development for nursing staff and school nurses around the state including work as a regular collaborator for the School Nurse Academy through Arkansas Children’s Hospital. Brittany Blankenship started her nursing ca- reer at Arkansas Children’s Hospital (ACH) working on a medical surgical floor caring for patients with a variety of illnesses while also specializing in patients with eating disorders, cystic fibrosis and diabetes for three and a half years. Brittany then transitioned to the endocrinology team as a diabetes specialty nurse at ACH. In June 2018, she was asked to relocate to Northwest Arkansas to become the Endocrinology specialty nurse at Arkan- sas Children’s Northwest (ACNW). Brittany is dedicated to growing the endocrine depart- ment at ACNW while continuing to educate patients, families and staff within the organi- zation and the surrounding community. REFERENCES Zeitler, P. (2019). Type 2 Diabetes in Youth: TODAY and Beyond [Powerpoint] Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., Zeitler, P. (2018). Evaluation and Management of Youth-Onset Type 2 Diabe- tes: A Position Statement by the American Diabetes Association. Diabetes Care. Https:// doi.org/10.2337/dci18-0052. Barkis, G., et al. American Diabetes Associa- tion Standards of Medical Care in Diabetes. Diabetes Care 2019; 42, Supplement 1.